CHARTER STUDENT ADMISSION APPLICATION

Student Information

Please enter the student's full legal name as shown on birth certificate. *Required Information

*First Name *

*Middle Name *

*Last Name *

*Suffix *

*Ethnicity *

*Race *

*Gender *

*Date of Birth * +

*Grade Applying For *

*School Year *

School District of Residence *

Student Identification

The Texas Student Data System matches students to their existing school records using one of the following identifiers. You may access your child's S-number or Texas Student Unique Identification on previous school records by contacting the child's previous school.

Please provide ONE of the following identifiers:

Social Security Number (SSN)

S-Number

Texas Student Unique Identification

My child has never been enrolled in Texas public schools.

*Providing a SSN is voluntary and used to match a student's Unique ID through the Texas Student Data System. If you do not wish to supply the SSN, please supply the S-number or Texas UID. If no S-number or Texas UID exists, one will be generated.

Additional Information

If Yes is selected, please enter the name of the Sibling, Staff, or Board Member.

I have another child applying to this charter school *

Yes

No No

I have another child attending this charter school *

Yes

No No

This is a child of a staff or board member. *

Yes

No No

My child may qualify for free prekindergarten, based on the following criteria: *

Yes

No

- is unable to speak and comprehend the English language; or

- is educationally disadvantaged; or

- is a homeless child, as defined by 42 United States Code § 11434a; or

- is the child of an active duty member of the armed forces of the United States; or

- is the child of a member of the armed forces of the United States, who was injured or killed while serving on active duty; or

- is or ever has been in the conservatorship of the Department of Family and Protective Services; or

- is the child of a person eligible for the Star of Texas Award.

Primary Guardian Information

*First Name *

*Last Name *

*Street Address of Primary Residence *

*City *

*State *

*Zip Code *

*Contact Phone Number *

Email Address *

Preferred contact *

Phone

Text Message

Email

*

CERTIFICATION (Required): By checking this box, I certify to the best of my knowledge and belief that the information in this application is complete and accurate, I am the legal guardian of the child listed above, and I understand that any false information, omission, or misrepresentation of facts may result in the rejection of this application or future dismissal of the applicant.

Pathway Academy does not discriminate on the basis of sex, national origin, ethnicity, religion, disability, or academic or athletic ability.